University of Alabama, Tuscaloosa, and University of Alabama at Birmingham, Birmingham, Alabama (T.P.)

Virginia Commonwealth University, Richmond, Virginia (L.J.S.)

Disclaimer: The statements presented in this work are solely the responsibility of the authors and do not necessarily represent the views of PCORI, its board of governors, or the methodology committee.

Financial Support: This work was funded partially by a PCORI Research Award (contract 941) and partially by the University of Alabama.

Disclosures: Dr. Thorn reports grants from PCORI and indirect cost recovery for research expenses from the University of Alabama during the conduct of the study and personal fees from Guilford Publications outside the submitted work. Drs. Eyer and Burns, Mr. Van Dyke, Ms. Newman, and Mr. Penn report grants from PCORI during the conduct of the study. Dr. Campbell reports grants from the University of Alabama and PCORI during the conduct of the study. Dr. Cheavens reports personal fees from the University of Alabama during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-0972.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.

290 participants were enrolled (70.7% of whom were women, 66.9% minority group members, 72.4% at or below the poverty level, and 35.8% reading below the fifth grade level); 241 (83.1%) participated in posttreatment assessments. Linear mixed models included all randomly assigned participants. Members of the CBT and EDU groups had larger decreases in pain intensity scores between baseline and posttreatment than participants receiving usual care (estimated differences in change scores—CBT: −0.80 [95% CI −1.48 to −0.11]; P = 0.022; EDU: −0.57 [CI, −1.04 to −0.10]; P = 0.018). At 6-month follow-up, treatment gains were not maintained in the CBT group but were still present in the EDU group. With regard to physical function, participants in the CBT and EDU interventions had greater posttreatment improvement than those receiving usual care, and this progress was maintained at 6-month follow-up. Changes in depression (secondary outcome) did not differ between either the CBT or EDU group and the usual care group.

Limitations:

Participants represented a single health care system. Self-selection bias may have been present.